3 Acute Pancreatitis Nile

Dr. MBA, I.
N - MBBS, FMCPath
Department of Chemical
Pathology, College of Health
Sciences
Nile University of Nigeria, Abuja.
Acute pancreatitis
July, 2023.
 Has endocrine and exocrine functions
 Essential endocrine organ that secretes insulin, glucagon,
pancreatic polypeptide and a number of other hormones
 Exocrine secretion of the pancreas include;
 Water
Pancreas  Mineral salts/ions (sodium, potassium, chloride and
bicarbonate)
 Enzymes; Amylase. Lipase, carboxypeptidase, elastase
inactivated enzyme precursors (trypsinogen,
chymotrypsinogen) etc
Primarily under the control of two hormones secreted by the
small intestine:
oSecretin ( stimulates the secretion of an alkaline fluid)
Pancreatic
oCCK (stimulates the secretion of pancreatic enzymes and
exocrine gallbladder contraction)
secretion
 Both hormones are secreted in response to the presence of
acid, amino acids and partially digested proteins
Inflammation of the pancreas
Commonly called “autodigestion of the pancreas” because

pancreatitis is an inflammatory process in which pancreatic
enzymes auto-digest the gland.
Pancreatitis  Comprises : Acute & Chronic Pancreatitis
 Both forms of pancreatitis may present in the emergency

department with acute clinical findings. (recurrence can
occur in chronic pancreatitis)
 Recognizing patients with severe acute pancreatitis as

soon as possible is critical for achieving optimal outcomes
Common causes are:
oAlcoholism
oGallstones
oComplication of radio-diagnostic procedures e,g ERCP
Acute o Idiopathic
Pancreatitis:
Causes Other less common causes:
oViral Infections
oHypercalcemia
oHypertriglyceridaemia
The initial lesion generates intracellular activation of enzyme precursors which can lead to
generation of free radicals and subsequent acute inflammatory response
The inflammation may go beyond the pancreas causing systemic inflammatory response
syndrome(SIRS)
ARDS , shock and renal failure may occur
Pathophysiology
o A known cause of acute abdomen
o Sudden onset pain commonly in the epigastric region that radiates to the
back
o Nausea, vomiting
o Anorexia.
o Hypotension
o Tachycardia
Clinical o Mild jaundice may be present
features o Abdominal distension with ileus ; marked tenderness & guarding
o Positioning ; the discomfort usually improves with the patient sitting up
and bending forward.
o Uncommon findings ;
 The Cullen sign is a bluish discoloration around the umbilicus resulting
from hemoperitoneum
 The Grey-Turner sign is a reddish-brown discoloration along the flanks
resulting from retroperitoneal blood dissecting along tissue planes
Primary tests
oSerum amylase; elevated ; levels 10x the upper limit of normal is
basically diagnostic (levels may not be that elevated though)
oSerum lipase ; elevated ( more specific than amylase)
oUrinary amylase; elevated
o Amylase exists as two isoenzymes: Amylase S & Amylase P
measurement of the pancreatic-specific isoenzyme (Amylase P)
Laboratory increases the diagnostic specificity of amylase tests
investigations
Secondary tests
o Blood glucose ( hyperglycaemia may be seen)
o SE/U/Cr, Ca, (hypocalcemia , azotemia may be present
o Lipid profile (especially triglyceride which is commonly elevated )
o Liver function test ( bilirubin & alkaline phosphatase may be slightly elevated)
o Arterial blood gases if a patient is dyspneic.
o Serum CRP ; used as a marker of severity and for monitoring response to Mgt
 Amylase is not specific for pancreatitis
 Elevations in serum amylase can occur in patients with small intestinal
obstruction, mesenteric ischemia, tubo-ovarian disease, renal
insufficiency, macroamylasemia. or parotitis.
 The serum half-life of amylase is short, and elevations generally return
to the reference ranges within a few days; so, it may not be useful in
late presentations
 Elevated lipase levels are more specific to the pancreas than elevated
Amylase vs amylase levels.
Lipase  Lipase has a slightly longer half-life and its abnormalities may support
the diagnosis if a delay occurs between the pain episode and time of
presentation by the patient (Lipase levels remain high for 12 days)
 The level of serum amylase or lipase does not indicate disease severity
and monitoring levels serially during the course of hospitalization does
not offer insight into the prognosis.
 a combination of amylase and lipase increases the diagnostic
sensitivity and specificity
Ultrasound
CTScan
Other
investigations Magnetic Resonance Cholangiopancreatography
Etc
oInfections
oPseudocyst
oPancreatic abscess
oPulmonary embolism
Complications oDIC
oDM
oPleural effusion; Pneumonia
oSIRS

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3 Acute Pancreatitis Nile

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Dr. MBA, I.

Commonly called “autodigestion of the pancreas” because

Pancreatitis  Comprises : Acute & Chronic Pancreatitis

 Both forms of pancreatitis may present in the emergency

 Recognizing patients with severe acute pancreatitis as

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